Application of the patient navigation model with people experiencing homelessness: a scoping review

Abstract Background Barriers in accessing healthcare services are a common issue that contributes to the disproportionately poor health outcomes in people who experience homelessness. A possible way to overcome these barriers and meaningfully engage with this under-served population is through the implementation of the so called patient navigation (PN) models. We conducted a systematic scoping review to gain a better understanding on how PN models are utilized with people experiencing homelessness and other comparable populations and to identify their features, barriers and facilitators to their implementation and their outcomes. Methods A systematic scoping review was done based on a predetermined protocol. We conducted a search of Web of Science, PubMed/Medline and Scopus databases on the 15th of June 2021. A narrative analysis of the included studies was conducted. Results Our search yielded 1203 hits, and after removing 475 duplicates, we were left with 728 publications of interest. Finally, 21 studies have been included in the review, comprising of nine review articles and 12 individual studies, with most studies stemming from the USA. Results show that PN models are consistently associated with improvements in a wide range of health related outcomes, mostly with timely access to healthcare services. Implementation strategies and measurements used in assessing PN models show heterogeneity between studies. However, a number of consistencies were found including; a longitudinal approach, using of non-clinical navigators who share similarities to the participant groups and who engage as facilitators. Additional considerations for gender and age may further improve the outcomes. Conclusions In order to improve on the success of the PN models and their application in removing barriers to healthcare access for people experiencing homelessness, more research is needed that focuses on the feasibility, acceptability and scalability of the approach outside the USA. Key messages • People experiencing homelessness experience considerable barriers in accessing healthcare service leading to disproportionately larger burden of disease as well as lower life expectancy. • Patient navigation models have a great potential in removing barriers and facilitating timely access to healthcare services in people experiencing homelessness.

Issue/Problem: Aging populations, worsening burden of chronic disease and recent pandemic has accelerated awareness and the importance of telemedicine in providing continuity of healthcare. Description of the problem: AGENAS is the public body responsible for the implementation of telemedicine investment (E1 billion) in the context of the NextGenerationEU plan. AGENAS has built up a working group expert panel to define the technical and informatics features of the investment. The project consists of the realization of the national telemedicine platform and the regional telemedicine services. Italian regions will implement telemedicine services based on the national guidelines defined by AGENAS, that will also monitor it through key performance indicators outlined on the basis of best practices and scientific evidence of multidimensional evaluation. Results: National telemedicine platform will improve, optimise and standardise telemedicine services throughout the Country, considering what may already be available in regional and local healthcare contexts. Regarding telemedicine services in regional context, that will be implemented within the NextGenerationEU, they will be focused on the telemonitoring of high prevalence conditions (i.e. cardiological, respiratory, diabetes, neurological and oncological) as well as other services such as televisit, teleconsultation and teleassistance. Connecting patient's home with healthcare system provide benefits for patients and their families, who will be able to interact with healthcare professionals, obtaining consultation and monitoring of their health.

Lessons:
The implementation of the investment, aiming at improving equity and integration of care, will contribute to provide real world evidence about usage, benefits and potential risk of the telemedicine in primary care for the management of chronic diseases.

Key messages:
The investment under the Next Generation EU plan it is the lifetime chance to transform Italian healthcare service and draw a new framework to cope with the high demand in telemedicine. Improving telemedicine services will determine a breakthrough in management of patient with chronic diseases in the Italian primary care sector. To promote mental health in this age group, this issue needs to be addressed, and community-based health promotion, in particular participatory interventions, are needed to make measures taken meaningful for youth. The aim of the study was twofold; to teach participatory mobile phone filmmaking to Youth Community Center (YCC) staff; and to investigate how they assess this method regarding feasibility, relevance, costs, resources needed, and time considerations. Methods: YCC staff participated in a two-day mobile phone filmmaking training. Group interviews that were recorded and transcribed verbatim were conducted and field notes were taken. Data was deductively analyzed in accordance with Elo and Kyngäs (2008).
Results: YCC staff found the technology was easily accessible and the method needs limited extra resources. It has the potential to promote creativity and can be used as a means to involve young people in describing the issue in their own words, and to find a solution to the issue at hand. The method also has the potential to reach and engage the whole community as organizing a mobile phone film event is part of the process. Time consumption was not perceived as an issue, as staff is free to plan activities as they see fit.

Conclusions:
According to YCC staff, participatory mobile phone filmmaking has the potential to promote positive interactions on social media among youth. This in turn has the potential to promote wellbeing of young people. Recommendations are that this method is tested among young people and investigate if it is a helpful intervention to promote mental health in this age group. Key messages: Participatory mobile phone filmmaking may be useful in youth mental health promotion. The method is cheap, easily accessible, and have the potential to involve the whole community.

Background:
Barriers in accessing healthcare services are a common issue that contributes to the disproportionately poor health outcomes in people who experience homelessness. A possible way to overcome these barriers and meaningfully engage with this under-served population is through the implementation of the so called patient navigation (PN) models. We conducted a systematic scoping review to gain a better understanding on how PN models are utilized with people experiencing homelessness and other comparable populations and to identify their features, barriers and facilitators to their implementation and their outcomes.

Methods:
A systematic scoping review was done based on a predetermined protocol. We conducted a search of Web of Science, PubMed/ Medline and Scopus databases on the 15th of June 2021. A narrative analysis of the included studies was conducted.

Results:
Our search yielded 1203 hits, and after removing 475 duplicates, we were left with 728 publications of interest. Finally, 21 studies have been included in the review, comprising of nine review articles and 12 individual studies, with most studies stemming from the USA. Results show that PN models are consistently associated with improvements in a wide range of health related outcomes, mostly with timely access to healthcare services. Implementation strategies and measurements used in assessing PN models show heterogeneity between studies. However, a number of consistencies were found including; a longitudinal approach, using of nonclinical navigators who share similarities to the participant groups and who engage as facilitators. Additional considerations for gender and age may further improve the outcomes.

Conclusions:
In order to improve on the success of the PN models and their application in removing barriers to healthcare access for people experiencing homelessness, more research is needed that focuses on the feasibility, acceptability and scalability of the approach outside the USA. Key messages: People experiencing homelessness experience considerable barriers in accessing healthcare service leading to disproportionately larger burden of disease as well as lower life expectancy. Patient navigation models have a great potential in removing barriers and facilitating timely access to healthcare services in people experiencing homelessness.
Poor access to quality health services, especially in urban slums, is a global challenge. Given similar challenges in Nairobi's Kibra informal settlement area, we collaborated with the Langata/Kibra sub-county health management team to conduct a pilot program for improving the quality of child health services delivered by health care providers (HCPs). The pilot introduced a digital mHealth platform to HCPs working in Kibra informal settlement area in Nairobi. This mHealth platform was compliant to WHO's recommended guideline for integrated management of newborn and child illnesses (IMNCI) and was designed to help sick child assessment, diagnosis and management by HCPs. We aimed to determine if using this digital platform, coupled with supportive supervision and community outreach, would lead to improve compliance to the IMNCI guideline for assessment, diagnosis and treatment of sick children. We conducted baseline (February 2019) assessment, trained selected HCPs on the mHealth platform on handheld android tablets, conducted end line (March 2020) and measured any change in HCP's compliance to IMNCI guidelines. Total 89 HCPs were the mHealth platform users during end line assessment. When asked about the choice of antibiotic for treating childhood pneumonia, we found proportion of HCPs who preferred Amoxycillin dispersible tablet, the recommended treatment for childhood pneumonia, increased from 3% at baseline to 38% at end line. Proportion of HCPs who were aware that antibiotics should NOT be used for the management of simple diarrhea increased from 14% (at baseline) to 50% (at end line). At end line, more than 90% HCPs were found compliant in their practice to IMNCI guidelines for sick child assessment, diagnosis and management. These results demonstrate the use of the IMNCI compliant mHealth platforms as a potential important effective way to improve capacity and compliance among HCPs who are serving communities like Kibra informal settlement in Nairobi, Kenya.

Background:
Digitalization has increased rapidly in health and social care and plays an increasingly important role in the daily work of health and social care professionals. The effects of digitalization are often viewed from the societal and economic perspectives, and less from the perspective of the changing health and social care work. This study examined how health and social care professionals perceive the effects of digitalization on their work.

Methods:
Eight semi-structured focus-group interviews were conducted in four Finnish health centers at the end of 2020. The participants (n = 30) were nurses, physicians, and social workers. Qualitative content analysis with inductive approach was used to analyze the data.

Results:
Four main categories emerged from the perceived effects of digitalization: 1) two-way changes in workload and pace (reduced/increased work, accelerated/slowed pace of work, duplication of work/saved employee resources), 2) changes in the content and nature of work (reallocation of work, emergence of new tasks, new skills needs, diversification of service provision), 3) changes in work community communication and interaction (improved interaction and communication, strengthened multidisciplinary collaboration, complicated remote interaction, reduced encounters) and 4) improved flow of patient information and information security (improved data transfer, patient monitoring and data protection).

Conclusions:
Digitalization-induced changes in health and social care work seem to be manifold and often two-sided. It has the potential to ease the work and offer other benefits, but at the same time it may complicate work in other respects, especially if the system does not support work tasks or the usability is poor. When implementing new digital services and pursuing benefits, more attention should be paid to assessing and considering the potential disadvantages to minimize additional strain among already burdened health and social care professionals.

Key messages:
The perceived effects of digitalization on health and social care work are often two-sided and can contribute to the well-being of professionals.
Monitoring the use of digital services and the experiences of professionals about them, as well as identifying their skills needs and training aspirations is crucial.